When it comes to treating attention-deficit/hyperactivity disorder (ADHD) in adults, the promise of medication often collides with the risks of addiction, discontinuation, and stigma—especially for those also struggling with substance use disorder (SUD). New research out of Sweden, published May 21, 2026 in BMJ Mental Health, highlights the precarious tightrope these individuals walk. The study found that adults with both ADHD and SUD are nearly twice as likely to stop their medication within a year compared to those with ADHD alone. But behind the numbers are human stories—stories like Shannon Anderson’s, a mother from Kansas City, Missouri, whose journey through addiction and recovery shines a light on the real-world stakes of this medical dilemma.
According to the Swedish cohort study, almost half (44%) of adults with ADHD and SUD discontinued their medication within one year of diagnosis or a first SUD-related event. That’s compared to just 25% in the ADHD-only group. The researchers defined discontinuation as a gap of 90 days or more without medication, based on prescription records. The risk was even higher for those with a history of abusing stimulants, cannabis, or multiple substances, and individuals with substance-related criminal justice involvement were the least likely to restart ADHD treatment. As the study authors wrote, “ADHD is often overlooked in prison populations and seldom treated appropriately.” They added, “Whether this is due to patients experiencing difficulties engaging and adhering to treatment regimens or whether healthcare providers are reluctant to prescribe stimulants to patients with ADHD and SUD in the presence of criminal history, or consider treating this patient group riskier and therefore more often discontinue treatment, is unclear.”
For Anderson, the journey into addiction began innocently enough. “After one pill, I was essentially hooked,” she told reporters. “The second that pill kicked in, a euphoria washed over me I had never felt before. Eventually, the addiction really took over and my tolerance had grown so much that I ultimately needed Adderall to function in my life.” Anderson’s story is not unique. She described obtaining her initial prescription about 15 years ago as “extremely easy,” recalling a process that involved a simple computer test: “You basically just sit in a room with a camera and a computer and have to press a space bar at certain times on the screen. Miss it a few times and voila, you have ADHD and get prescribed controlled substances.”
At her lowest, Anderson was taking 300mg of dextroamphetamine daily—more than seven times the recommended dose. The physical and mental toll was brutal: chronic dry eye from forgetting to blink, persistent hives, jaw movements she likened to “a crack addict,” a jugular vein pulsing visibly in her neck, pupils so dilated they drew comments, and a wave of paranoia and hallucinations from constant sleep deprivation. “Adderall or stimulants make you extremely anxious. With lack of sleep added into the mix, you start to hallucinate,” she recounted.
Her turning point came during a conversation with intravenous drug users. “I kept seeing myself as different and not an addict, but that moment made me realise I was an addict. The substance doesn’t matter. That’s when I knew it was life or death.” Anderson sought help through 12-step meetings and eventually founded Sober is Chic, a business aimed at supporting others facing similar battles. She’s observed that the problem may be worsening with the advent of virtual appointments, making it easier for people to obtain multiple prescriptions. “I’ve had clients that have shared the same experiences. I’ve had family members reach out to me on social media saying their loved ones were able to get them through virtual appointments—which wasn’t a thing when I was using. So they were able to have multiple doctors prescribe them.”
Anderson’s experience underscores a broader epidemic. “This is definitely an epidemic,” she said, noting that she’s met countless others with similar stories since going public. But she’s also faced criticism, with some blaming people like her for medication shortages or prescriber hesitancy. “Neither of those things was ever my experience. I think it is probably just a result of the overprescribing of this medication.”
The Swedish study’s findings dovetail with Anderson’s cautionary tale, but they also complicate the narrative. While the abuse potential of stimulants is a real concern, experts like Dr. Timothy E. Wilens, speaking in an ADDitude webinar, stress that properly managed ADHD medication does not cause future drug misuse or addiction. “In fact, the opposite appears to be true,” Wilens explained. “Studies show that early treatment of ADHD and its continued treatment across the lifespan reduce risk for substance use and SUDs.” The Swedish data also revealed that lower doses—often prescribed out of caution—did not improve adherence, while higher doses did. This suggests that patients who tolerate stimulants well are more likely to stick with treatment, which can, in turn, reduce criminal behaviors and other harms.
Indeed, a 2012 Swedish study of 26,000 adults with ADHD found that crime rates dropped by 32% for men and 41% for women who took their medication. And a 2025 BMJ study linked ADHD medication to lower rates of suicidality, criminal behaviors, vehicular accidents, and substance misuse. “This may be because people with multiple occurrences of such events typically have more severe ADHD, making them more likely to benefit from drug treatment,” the authors wrote. “Additionally, the cumulative effect of ADHD drug treatment may lead to additive improvements over time, whereas negative consequences may accumulate the longer an individual goes untreated.”
But adherence remains a challenge, especially for young adults. The Swedish study found that those aged 18 to 24 or younger at their first SUD event were more likely to stop and less likely to restart medication. The researchers stressed the importance of improving treatment access and continuity of care, especially during the vulnerable transition from adolescence to adulthood. They also noted that individuals with ADHD and SUD were more likely to change providers and medication types between discontinuation and reinitiation, possibly reflecting difficulties accessing care, stigma, and low health literacy.
With 55,684 people aged 16 to 26 included in the Swedish study—9,283 with both ADHD and SUD and 46,401 with ADHD only—the scale of the challenge is clear. According to Wilens, about one in two adolescents and one in four adults with SUD has co-occurring ADHD, and the risk for SUD is even higher among those with untreated ADHD. “Given the known links between ADHD and SUD, adolescents and adults with SUDs or problematic substance use should be screened for ADHD,” he advised. Structured therapies, such as cognitive behavioral therapy (CBT) combined with medication, are considered most effective for individuals with both conditions.
For Anderson, recovery is an ongoing process. She’s candid about the challenges, including frequent panic attacks in sobriety. “I was so used to taking something when those feelings came on before. This was new territory for me,” she said. Yet her message remains one of hope: “You can do this. Stop telling yourself you can’t. Your addiction will kill you. And if it doesn’t, you will live a miserable existence until something else does. It’s life or death and it’s time to choose life.”
As research and personal stories converge, the message is clear: effective, compassionate, and continuous care is vital for those living at the intersection of ADHD and substance use disorder. The stakes, for many, are nothing less than life itself.